Guidelines for Evaluation of Permanent Physical Impairmentin Upper Limbs Motor vehicle accident ts claims cases

Guidelines for Evaluation of Permanent Physical Impairmentin Upper Limbs Motor vehicle accident ts claims cases

1. The estimation of permanent impairment depends upon the

measurement of functional impairment, and is not expression of

a personal opinion.

2. The estimation and measurement must be made when the

clinical condition is fixed and unchangeable.

3. The upper extremity is divided into two component parts the

arm component and the hand component.

4. Measurement of the loss of function of arm component

consists in measuring the loss of motion, muscle strength an coordinated

activities.

5. Measurement of the loss of function of hand component

consists in determining the Prehension, Sensation & Strength.

For estimation of Prehension: Opposition, lateral pinch,

Cylindrical grasp, spherical grasp and hook grasp have to be

assessed as shown in the column of “prehension” component in

the proforma.

6. The impairment of the entire extremity depends on the

combination of the functional impairment of both components.

ARM COMPONENT:Total

value of arm component is 90%.

Principles of Evaluation of range of motion of joints

1. The value for maximum R.O.M. in the arm component is

90%.

2. Each of the three joints of the arm is weighted equally (30%).

Example

Fracture of the right shoulder joint may affect range of motion

so that active adduction is 90degree. The left shoulder exhibits

a range of active abduction of 180degree. Hence there is loss of

50% of abduction movement of the right shoulder. The

percentage loss of arm component in the shoulder is 50 x 0.03

or 15% loss of motion for the arm component.

If more than one joint is involved, same method is applied, and

the losses in each of the affected joints are added.

Say for example:Loss

of abduction of the shoulder = 60%

Loss of extension of the wrist = 40%

Then, loss of range of motion for the

arm = (60 x 0.30) + (40 x 0.30) = 30%

Principles of Evaluation of strength of muscles:1.

Strength of muscles can be tested by manual testing like 05

grading.

2. Manual muscle gradings can be given percentages like

3. – 100%

4. – 80%

5. – 60%

6. – 40%

7. – 20%

8. – 0%

9. The mean percentage of muscle strength loss is multiplied by

0.30.

If there has been a loss of muscle strength of more than one

joint, the values are added as has been described for loss of

range of motion.

Principles of Evaluation of coordinated

activities:1.

The total value for coordinated activities is 90%.

2. Ten different coordinated activities are to be tested as given

in the Proforma.

3. Each activity has a value of 9%.

Combining values for the Arm Component:1.

The value of loss of function of arm component is obtained

by combining the values of range of movement, muscle strength

& coordinated activities, using the combining formula

A+ B (90A)/90

Where 'A' = higher value & 'B' = lower value

Example

Let us assume that an individual with a fracture of the right

shoulder joint has in addition to 16.5% loss of motion of his

arm, 8.3% loss of strength of muscles, and 5% loss of coordination.

We combine these values as :

Range of motion : 16.5%

Strength of Muscles : 8.3%

Result A16.5

+8.3(9016.5)/

90 =23.3 %

Coordination

: 5%

Result B

23.3

+ 5(9023.3)/

90 =27.0%

So total value of arm component = 27.0%

HAND COMPONENT:Total

value of hand component is 90%.

The functional impairment of hand is expressed as loss of

prehension, loss of sensation, loss of strength.

Principles of Evaluation of Prehension :Total

value of Prehension is 30%. It includes :

(A) Opposition (8%). Tested against

Index finger (2%). Middle finger (2%)

Ring finger (2%) & Little finger (2%)

(B) Lateral Pinch (5%). Tested by asking the patient to hold a

key.

(C) Cylindrical Grasp (6%). Tested for

(D) Large object of 4 inch size (3%)

(E) Small object of 1 inch size (3%)

(F) Spherical Grasp (6%). Tested for

(G) Large object 4 inch size (3%)

(H) Small object 1 inch size (3%)

(I) Hook Grasp (5%). Tested by asking the patient to lift a bag.

Principles of Evaluation of Sensations:Total

value of sensation is 30%. It includes :

1. Grip Strength (20%)

2. Pinch Strength (10%)

3. Strength will be tested with hand dynamometer

or by clinical method (Grip Method).

10% additional weightage to be given to the following factors :

1. Infection

2. Deformity

3. Malaignment

4. Contractures

5. Cosmetic appearance

6. Abnormal Mobility

7. Dominant Extremity (4%)

Combining values of the hand component:The

final value of loss of function of hand component is

Obtained by summing up values of loss of prehension, sensation

and strength.

Combining Values for the Extremity:Values

of impairment of arm component and impairment of

hand component are combined by using the combining formula.

Example

Impairment of the arm = 27% 64 +27(9064)/

90=71.8%

Impairment of the hand = 64%